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  • EP133 Single-bolus injection of local anaesthetics, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomised controlled trial

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EP133 Single-bolus injection of local anaesthetics, with or without continuous infusion, for interscalene brachial plexus block in the setting of multimodal analgesia: a randomised controlled trial
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  1. Patrick Rhyner1,
  2. Matthieu Cachemaille2,
  3. Patrick Goetti3,
  4. Jean-Benoit Rossel4,
  5. Melanie Boand5,
  6. Alain Farron3 and
  7. Eric Albrecht5
  1. 1Department of Anaesthesia, Ensemble Hospitalier du Nord Vaudois, Yverdon-les-Bains, Switzerland
  2. 2Chronic pain clinic, Hôpital de laTour, Meyrin, Switzerland
  3. 3Department of Orthopaedic surgery, University Hospital of Lausanne, Lausanne, Switzerland
  4. 4Primary Care and Public Health Center (Unisanté), University of Lausanne, Lausanne, Switzerland
  5. 5Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland

Abstract

Background and Aims Previous trials favoured a continuous interscalene brachial plexus block over a single injection for major shoulder surgery. However, these trials did not administer a multimodal analgesic regimen. The null hypothesis of this randomised, controlled trial is that a continuous infusion of local anaesthetic after a single injection for an interscalene brachial plexus block does not provide additional analgesia after major shoulder surgery in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac.

Methods Sixty patients undergoing shoulder arthroplasty or arthroscopic rotator cuff repair were randomised to receive a bolus of ropivacaine 0.5%, 20mL, with or without a continuous infusion of ropivacaine 0.5% 4–8 mL.h-1, for an interscalene brachial plexus block. Patients were provided with intravenous morphine patient-controlled analgesia. The primary outcome was cumulative intravenous morphine consumption at 24h postoperatively. Secondary outcomes included pain scores at rest and on movement, and functional outcomes, measured over 48h after surgery.

Results Median (interquartile range) cumulative intravenous morphine consumption at 24h postoperatively was 10mg (4–24) in the continuous infusion group and 14mg (8–26) in the single injection group (p=0.74). No significant between-group differences were found for any of the secondary outcomes.

Conclusions A continuous infusion of local anaesthetics after a single injection for an interscalene brachial plexus block does not provide additional analgesia after major shoulder surgery in the setting of multimodal analgesia, inclusive of intravenous dexamethasone, magnesium, acetaminophen and ketorolac. The findings of this study are limited by performance and detection biases.

View this table:
Abstract EP133 Table 1

Patient demographics and clinical characteristics. Continuous data are presented as mean and standard deviation, and compared using student’s t-tests; categorical data presented as number of patients (%) and compared using chi-squared tests

Abstract EP133 Figure 1
Abstract EP133 Figure 1

Morphine consumption

Abstract EP133 Figure 2
Abstract EP133 Figure 2

Pain scores

Ethics comitee approval 02.2020

  • regional anaesthesia
  • peripheral nerve block
  • perineural catheter
  • postoperative analgesia
  • interscalene brachial plexus block
  • shoulder arthroplasty
  • rotator cuff repair.

https://doi.org/10.1136/rapm-2023-ESRA.194

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